Affiliation:
1. Department of Cardiology Boston Children's Hospital Boston MA
2. Department of Medicine Brigham and Women's Hospital Boston MA
3. Harvard Medical School Boston MA
4. Department of Psychiatry Brigham and Women's Hospital Boston MA
5. Discipline of Paediatrics School of Women's and Children's Health The University of New South Wales Sydney NSW Australia
Abstract
Background
In adults with acquired heart disease, depression is common and associated with adverse outcomes. Depression may also be important in adults with congenital heart disease (
CHD
).
Methods and Results
We conducted a cohort study of outpatients with
CHD,
aged ≥18 years, enrolled in a prospective biobank between 2012 and 2017. Clinical data were extracted from medical records. Survival analysis assessed the relationship between depression, defined by a history of clinical diagnosis of major depression, with all‐cause mortality and a composite outcome of death or nonelective cardiovascular hospitalization. A total of 1146 patients were enrolled (age, 38.5±13.8 years; 49.6% women). Depression had been diagnosed in 219 (prevalence=19.1%), and these patients were more likely to have severely complex
CHD
(41.3% versus 33.7%;
P
=0.028), cyanosis (12.1% versus 5.7%;
P
=0.003), and worse functional class (≥
II
; 33.3% versus 20.4%;
P
<0.0001), and to be taking antidepressant medication at time of enrollment (68.5% versus 5.7%;
P
<0.0001). Depression was associated with biomarkers indicative of inflammation (hsCRP [high‐sensitivity C‐reactive protein], 1.71 [25th–75th percentile, 0.82–4.47] versus 1.10 [0.45–2.40];
P
<0.0001) and heart failure (NT‐proBNP [N‐terminal pro‐B‐type natriuretic peptide], 190 [92–501] versus 111 [45–264];
P
<0.0001). During follow‐up of 605±547 days, 137 participants (12.0%) experienced the composite outcome, including 33 deaths (2.9%). Depression was associated with increased risk for both all‐cause mortality (multivariable hazard ratio, 3.0; 95%
CI
, 1.4–6.4;
P
=0.005) and the composite outcome (multivariable hazard ratio, 1.6; 95% CI, 1.1–2.5;
P
=0.025), adjusting for age, sex, history of atrial arrhythmia, systolic ventricular function,
CHD
complexity, and corrected QT interval.
Conclusions
In adults with CHD, major depression is associated with impaired functional status, heart failure, systemic inflammation, and increased risk for adverse outcomes.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
27 articles.
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